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Organization:

SHSO-Sutter Health System Office-Valley

Position Overview:

The position is responsible for participating in the negotiations for payer agreements for commercial and government sponsored products as assigned for Sutter hospital, professional and ancillary providers. The primary focus of this position is to support or lead payer negotiations, implementation of the managed care payer agreements and contract compliance, including performance analysis and recommendations for modifications. Additionally, assures the success of contract performance and works through any contract or claims disputes as well as support dispute litigation.

Negotiations of proposed and/or existing payers or third-party payer managed care contracts. Supports the negotiation process and documentation process for non-contracted payers via Letters of Agreements within parameters. Monitors contract performance and compliance. Works with appropriate departments to develop and ensure contract compliance.

This is a work from home role with some onsite meetings. The successful candidate will live in the Sutter footprint.

Job Description :

EDUCATION:

Equivalent experience will be accepted in lieu of the required degree or diploma.

• Bachelor's: Healthcare Administration, Business Administration or related healthcare field

TYPICAL EXPERIENCE:

• 8 years recent relevant experience

SKILLS AND KNOWLEDGE:

• Strong Knowledge of market imperatives, provider payment terms and trends for healthcare providers.

• Ability to perform managed care contract analysis, draft language, document review, and work with operational teams and Payer representatives to support contract compliance.

• Advanced knowledge of the operational implications of managed care contracts relative to both medical groups, ancillary providers and hospitals for all types of Payer products, commercial and government sponsored.

• An understanding of all regulatory requirements for contracting and compliance as it relates to Knox-Keene, Department of Managed Health Care, Department of Insurance, Medi-Cal, CMS, HIPAA or ERISA.

• Ability to influence and facilitate work teams to ensure the effective management of complex, multi-faceted issues, including leading operational meetings.

• Ability to build consensus through effective communication skills both written and oral.

• Strong knowledge of all types of provider reimbursement, including value-based payments.

• Must be able to enlist cooperation and commitment to carrying out initiatives related to contract compliance or operational implementation.

Job Shift :

Days

Schedule :

Full Time

Shift Hours:

8

Days of the Week:

Monday - Friday

Weekend Requirements:

None

Benefits:

Yes

Unions:

No

This position is work from home eligible.

Position Status:

Exempt

Weekly Hours:

40

Employee Status:

Regular

Number of Openings:

1

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $57.22 to $85.83 / hour

The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.

All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.